分流与显微手术治疗颅内动脉瘤的临床比较

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-05-01 DOI:10.1016/j.jocn.2025.111296

Samer S. Hoz , Li Ma , Prateek Agarwal , Rachel C. Jacobs , Alhamza R. Al-Bayati , Raul G. Nogueira , Georgios A. Zenonos , Paul A. Gardner , Robert M. Friedlander , Michael J. Lang , Bradley A. Gross

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引用次数: 0

摘要

背景动脉瘤再治疗的目标是有效、持久的闭塞。血流转移（FD）和显微手术夹闭通常是动脉瘤治疗的两种高闭塞率的选择。然而，它们在动脉瘤再治疗中的相对疗效很少得到评估。因此，我们试图比较显微手术和FD治疗颅内动脉瘤（IA）的放射学和神经学结果。方法回顾单一机构数据库，以确定在两年内通过FD或显微手术进行IAs再治疗的患者。比较两种再治疗方式和亚组间的脑湮没率和神经学预后。通过多因素logistic回归分析调整再治疗方式的影响。结果共发现67例再治疗，其中显微手术占60%，FD占40%。显微手术多见于前交通动脉（Acomm）动脉瘤（p = 0.04）；10 mm (p = 0.02)，动脉瘤最初在血管内治疗（p = 0.02）。FD在ICA动脉瘤中更为常见（p = 0.01），残余尺寸>；10 mm （p = 0.02）。在中位随访26个月时，两种再治疗方式的血管造影闭塞率和神经预后总体上相似。随访12个月后，显微手术后Raymond I型闭塞率为94.9%，FD后为95.2% （p = 1.00）。FD和显微手术的良好神经预后（mRS 0-2）相似（92.6%比90%，p = 1.00）。在几个亚组中观察到类似的结果，包括先前破裂的动脉瘤和需要在6个月内再治疗的动脉瘤。与显微手术后10%的主要并发症发生率相比，FD后无重大事件发生（p = 0.14）。结论经2年随访，fd与显微手术的疗效和神经预后相当，是血管内治疗IA的合适选择。长期随访对于更准确地确定治疗效果至关重要。

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Clinical comparison of flow diversion and microsurgery for retreatment of intracranial aneurysms

Background

The goal of aneurysm retreatment is effective, durable obliteration. Flow diversion (FD) and microsurgical clipping generally represent two aneurysm treatment options with high obliteration rates. However, their relative efficacy in aneurysm retreatment has been infrequently evaluated. We thus sought to compare the radiographic and neurological outcomes of microsurgery to FD for retreatment of intracranial aneurysms (IA)s.

Method

A single institution database was reviewed to identify patients undergoing retreatment for IAs over a two-year period via either FD or microsurgery. Obliteration rates and neurological outcomes were compared between the two retreatment modalities and across subgroups. Impact of retreatment modality was adjusted via multivariate logistic regression analyses.

Results

Sixty-seven retreatments were identified, 60 % via microsurgery and 40 % via FD. Microsurgery was more commonly performed for anterior communicating artery (Acomm) aneurysms (p = 0.04), residual size < 10 mm (p = 0.02), and aneurysms initially treated endovascularly (p = 0.02). FD was more commonly performed for ICA aneurysms (p = 0.01) and residual size > 10 mm (p = 0.02). Angiographic obliteration rates and neurological outcome were similar overall between the two retreatment modalities at a median follow-up of 26 months. Raymond I obliteration after 12-month follow-up was 94.9 % after microsurgery and 95.2 % after FD (p = 1.00). Good neurological outcome (mRS 0–2) was similar between FD and microsurgery (92.6 % versus 90 %, p = 1.00). Comparable outcomes were observed across several subgroups, including previously ruptured aneurysms and aneurysms requiring retreatment within 6 months. Compared with a 10 % major complication rate after microsurgery, no major events occurred after FD (p = 0.14).

Conclusion

FD is an appropriate endovascular option for IA retreatment, with comparable efficacy and neurological outcome to microsurgery at 2-year follow-up. Longer-term follow-up will be critical to more accurately determine therapeutic efficacy.

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.